Pelvic organ prolapse severe enough to result in surgical repair in over 200,000 women each year and is anticipated to increase in prevalence with our aging population. However, the rate of surgical intervention failure is significant and anterior compartment prolapse is the most common site of failure. Lack of the ability to identify the specific combination of site and magnitude of structure defects leading to her prolapse and predict the success of a given operative strategy in a given specific woman limit our ability to understand operative failure and hinge the effective surgical planning and treatment innovation. Given this knowledge gap, we propose to develop a computer modeling approach that will allow surgeons to evaluate the outcome of various pelvic floor surgical strategies in individuals with different types and combinations of pelvic support defects. We seek funding to establish the conceptual framework and demonstrate the feasibility by focusing on apical suspension surgeries such as abdominal sacrocolpopexy surgery for anterior compartment predominant prolapse. Aim 1, Create subject-specific biomechanical prediction models based on the multiple structural failure hypothesis and validate those model predictions against post-operative MRI measurements. Aim 2, Conduct sensitivity analyses, systematically study how various pre-operative structural impairments and combinations of structural impairments affect apical suspension surgery outcome, and identify impairment combinations and thresholds beyond which apical suspension surgery alone is not adequate to restore anterior compartment support. These models can be extended to predict the outcome of other surgical approaches such as the paravaginal repair and midline anterior colporrhaphy as well as their interaction with apical suspension surgery in the subsequent R01. These complete and validated models could be used as experimental platform allowing surgeons and biomedical design engineers answer the questions regarding to surgical planning and treatment innovations in a fast, safe and generally inexpensive manner and minimize potential harm for women who undergo pelvic prolapse surgery.